Long-Term Care of Pediatric Cancer Survivors Important Focus for UChicago

Over four decades ago, the chance of surviving childhood cancer was slim. Today, 80% of all pediatric cancers are cured. While this is a tremendous success, childhood cancer survivors are at greater risk for developing significant long-term health issues that can be attributed to their cancer treatments.

The Childhood Cancer Survivors Center at UChicago screens for and treats secondary health issues in patients diagnosed with cancer before age 21. “We aim to educate pediatric and adult cancer survivors so that they are aware of their risks and realize that they need life-long follow-up care,” said Tara Henderson, MD, MPH, assistant professor of medicine and director of the Childhood Cancer Survivors Center.

Pediatric cancer survivors are at risk for a myriad of medical problems based on treatments they have received. “They can have issues with their teeth, eyes, heart, lungs, fertility, growth and development, cognition and learning, and psychiatric disorders. Anything that chemotherapy and radiation touch can cause subsequent problems,” explained Dr. Henderson. Radiation therapy and certain types of chemotherapy are also associated with the development of secondary cancers.

In 2009, more than 100 children were diagnosed and/or received initial treatment for cancer at Comer Children’s Hospital. The Childhood Cancer Survivors Center coordinates its work with pediatric and adult subspecialty care throughout the hospital, including endocrinology, cardiology, and dermatology. Patients are screened for long-term health problems and second malignancies. For example, children who have received radiation therapy are referred to a dermatologist to determine if there are any changes in their skin, and women who have received chest radiation for a childhood malignancy are screened more aggressively for breast cancer with mammography and MR imaging starting at age 25 or 8 years after they received radiation therapy.

Many cancer survivors are not aware that they are at increased risk for health issues. Before any patient comes to the clinic, the center develops a medical summary to review with the patient. “We spend a lot of time on education. We want our patients and their families to understand their past disease as well as the particular health risks associated with the medications and medical procedures they have received.” The center also educates patients on how to lead healthy lifestyles.

Dr. Henderson and her colleagues are currently surveying 1,500 members of the American Academy of
Family Physicians to assess their knowledge on the care of childhood cancer survivors. “Many patients don’t have access to pediatric cancer centers, so they see their primary care physicians. It is very important that we educate primary care physicians about the long-term health risks for pediatric cancer survivors,” said Dr. Henderson.

“Survivorship care can significantly improve quality and length of life,” said Dr. Henderson. “This is really important because one in every 450 young adults is a childhood cancer survivor.”

UChicago recently joined the Childhood Cancer Survivorship Study, the largest cohort study of 14,000 childhood cancer survivors diagnosed at 30 medical institutions in North America. Dr. Henderson’s own research focuses on the health behaviors and outcomes of childhood cancer survivors. She has a particular interest in secondary cancers and recently determined the impact of surveillance on the development of breast cancer and identified the risk factors for gastrointestinal malignancies in these patients. Her work will facilitate the development of improved screening guidelines for these cancers.